Individual
JENNIFER DIANE MANSKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
847 NE 19TH AVENUE, SUITE 100, PORTLAND, OR 97232
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201392661
OR
Other
Enumeration date
08/12/2015
Last updated
08/12/2015
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